Diseases of the duodenum: symptoms, therapy, diagnostic methods. Methods for examining the stomach and duodenum

The duodenum (DU) is part of the human intestine. It is located in the retroperitoneal space (retroperitoneal). What is KDP? The duodenum looks like a tube connecting the stomach to the small intestine. It has a hole in the middle through which pancreatic enzymes enter. This is the initial and shortest segment of the intestine.

The duodenum received its name because of its length, which is approximately 30 cm, which corresponds to 12 fingers. The anatomy of the duodenum, like the stomach, includes division into sections that differ in outer covering and length.

Where is the duodenum located? It is usually located at the level of the L2-L3 spinal segment. Depending on height, weight, and body type, a person may move lower. It ends near the third lumbar vertebra. The duodenum has a single blood supply system, and lymph outflow occurs through the walls of the head of the pancreas. Diseases of the duodenum are a common phenomenon in the modern world.

Structure and functions

The duodenum can be C-shaped, V-shaped, U-shaped. Each of them is a variant of the norm. Despite its small size, the anatomical structure of the duodenum includes 4 sections:

• upper horizontal (bulb) – 5-6 cm long, covered with a thin layer of muscles, located on the border of the last thoracic and first lumbar vertebrae;
• descending - 7-12 cm long with pronounced circular folds, detected to the right of the first 3 lumbar vertebrae;
• lower horizontal – 6-8 cm long, covered with a shell in front, located at the level of the third lumbar vertebra;
• ascending – 4-5 cm long, located near II lumbar vertebra. Sometimes it can be unclearly expressed, creating the effect of absence.

The first section is located near the liver, touching the kidney from below. Posteriorly it contacts the retroperitoneal tissue. Diseases of the duodenum can affect any of its parts.

The wall of the duodenum has a complex structure, consisting, like the anatomy of the stomach, of several membranes:

• mucous membrane - with circular folds, microscopic villi;
• submucosa - made of loose connective tissue with collagen fibers and many blood vessels;
• muscle tissue - has smooth fibers, regulates muscle tone, helps move chyme into the intestines;
• serous membrane - formed from squamous epithelium, prevents friction of the duodenum against other organs.

The duodenum is located at the junction of the stomach, gallbladder with bile ducts, pancreas, liver, and right kidney.

Functions of the duodenum:

• secretory - helps mix food with digestive juices;
• reflex - with its help, a connection is maintained with the stomach, allowing the gastric pylorus to open and close;
• motor secretion helps the food mass move;
• regulatory – controls the production of food enzymes;
• the protective function allows you to maintain a normal alkaline level for the body in chyme;
• The principle of evacuation capability is to move chyme to other departments.

Normal operation The stomach and duodenum are needed for the smooth functioning of the whole organism.

Diseases and their prevention

Due to the influence of various external factors, heredity, infection Helicobacter pylori, background pathologies, as well as age, changes appear that affect the functioning of the duodenum.

How does the affected area hurt? Discomfort is usually localized in the upper abdomen. Diseases of the duodenum are also manifested by other symptoms: heartburn, nausea, and upset stool. The most common diseases of the stomach and duodenum:

• duodenitis - inflammation of the mucous membrane of the duodenum, disrupting its normal functioning;
• ulcer – the formation of a defect in the wall of an organ;
• gastritis – inflammatory process gastric mucosa;
• cancer – the appearance of a malignant tumor.

To reduce the risk of duodenal disease, it is recommended to adhere to a proper diet. It should consist of 5-6 daily meals. In this case, food is consumed in small portions and chewed thoroughly. Prevention of gastric and duodenal ulcers also involves giving up bad habits, since smoking and alcohol abuse are serious provoking factors.

It is better to prepare dishes by steaming, stewing or baking. Carbonated drinks, strong tea and coffee should also not be consumed. Marinades, pickles, smoked meats, fatty, spicy foods should be excluded.

The main prevention of duodenal ulcers is to minimize stress factors. Moderate physical activity will also be beneficial, and an annual medical examination will help identify pathologies on the early stages, which will greatly facilitate the treatment process and further prognosis.

Duodenum - important organ The gastrointestinal tract, which has a complex structure and performs functions that contribute to normal digestion. Disturbances in its functioning affect the entire body, worsening the quality of human life. Regular medical examination proper nutrition, sufficient physical activity helps control the health of the duodenum and prevent duodenal diseases.

Rental block

A method for studying the mechanism of pancreatic secretion, the composition of pancreatic juice and the influence of various conditions, primarily nutritional factors, on the secretion of juice was developed by I.P. Pavlov and his school. Pavlov was the first to develop a method for obtaining pure pancreatic juice for a long time by imposing a permanent pancreatic fistula on an animal. Pavlov's technique enabled him and his students (S.G. Mett, L.B. Popelsky, A.A. Walter, I.A. Dolinsky, I.P. Razenkov, etc.) to study in detail pancreatic secretion under various production conditions experience and thereby gain an understanding of the physiological processes of this organ. Subsequently, a study of pancreatic secretion in humans was carried out by K.M. Bykov and G.M. Davydov in a patient with a chronic pancreatic fistula, as well as in the clinic by using a double probe, which makes it possible to obtain duodenal contents separately from the gastric contents.

Additionally: To study the composition and effect of digestive juices, it was necessary to obtain them in pure form. Before Pavlov, none of the physiologists could achieve this. For example, the following operation was considered the highest achievement. To obtain pancreatic juice, a dog was opened abdominal cavity, found the gland and its duct; the duct was cut, a glass tube was inserted into it, and in those few minutes while the animal was still alive, a few drops of pure juice were obtained. I.P. Pavlov came out strongly against such operations. That is why, he said, the study is at a dead end digestive glands that juices that are either contaminated or obtained from a dying animal are being studied. Such data cannot advance science forward. Having completed his research on the physiology of blood circulation, I. P. Pavlov set about overcoming the difficulties facing the science of digestion, and not only brought this section of physiology out of a dead end, but also created a fundamentally new physiological technique. As we have already said, instead of the method of acute experiments carried out on the operating table, Pavlov introduced the method of chronic experiments into physiology, which opened a new era in the development of our science - the era of synthesis. To obtain pure pancreatic juice from a healthy dog, I. P. Pavlov opened the abdominal cavity of the animal and, having found the gland duct, did not cut it, but looked for the place of the duodenal wall where the duct flows. Pavlov cut out this piece of the wall, thereby completely separating the duct from the intestine without damaging it at all. Next, having sewn up the resulting hole in the intestine, the experimenter sewed a piece of its wall with a duct opening on it to the edges of the abdominal wound with the duct opening outward. It turned out that the pancreatic juice now flowed not into the intestine, but outward, into a funnel placed by the experimenter. A few days later the dog recovered from the operation, and now for a number of years it was possible to obtain pure pancreatic juice from a completely healthy animal while the gland was working. In the presence of other glands, the absence of juice from one of them did not lead to disruptions in vital functions. This is a remarkable property of the symphony of life - here, for the most part, there is redundancy, multiple provision of functions, due to which there are always or almost always reserve capabilities. In a similar way, I. P. Pavlov received both pure saliva and bile. Since the stomach does not have large glands ducts of which could be withdrawn, Pavlov simply “cut out” a small ventricle from the stomach, which connected it to the outside world. The cavity of the artificial stomach was separated from the cavity of the large stomach, but all the vessels and nerves were preserved. As a result, the animal had two stomachs - one for the dog, the other for science. Intestinal juice was studied in a similar way. One of the loops of the small intestine was cut out (preserving its mesentery, containing blood vessels and nerves) and its ends were sewn into the skin of the abdomen. Now it was possible not only to collect the juice, but also to monitor the movements of the intestine: an object was inserted into one end of it, for example a small ball, which fell out of the other end of the isolated intestinal loop. Pavlov developed an operation that was absolutely exceptional in its boldness in order to obtain large quantities of gastric juice. Back in 1842, the Russian surgeon Basov proposed making a gastric fistula - inserting a tube into the stomach (through an incision in the abdomen), which would then allow the contents of the stomach to be obtained at any time. Basov's operation was the forerunner of Pavlov's chronic experiments. However, the juice was unclean, mixed with food debris. That's why Pavlov designed a small ventricle. At the same time, a new task emerged. The juice was necessary not only for scientists, but also for patients suffering from decreased gastric secretion. In order to obtain large quantities of pure juice, Pavlov proposed the following. Dogs with Basovian gastric fistula underwent a second operation. He cut their esophagus and sewed both ends of it with the holes outward to the skin. After such an operation, not a single drop of food contaminated the gastric juice. When eating, the swallowed pieces of food immediately fell back into the cup, the dog swallowed them again, etc. She could eat the same pieces for 3-4 hours in a row, and whole liters of pure juice flowed from the stomach. Pavlov called this remarkable experience “imaginary feeding”, and dogs with such an operation - “milch cows of gastric juice.” How, the reader will ask, could dogs live if the swallowed food did not enter the stomach? Apparently, other readers will explain to him that through the same fistula through which the juice flows, the stomach can be “loaded” with food. Is it acceptable to torture an animal like this? Really, there is no torment here. On the contrary, the process of eating for a long time without satiation is not a pleasure? One of the greatest benefits that the holy scriptures of Muslims promise to the righteous in paradise is love pleasures with houris that do not lead to saturation.

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Anatomy of the duodenum

The duodenum (duodenum, Fig. 415) occupies a somewhat separate place in the small intestine, due to its anatomical and physiological characteristics.

1 - upper part of the intestine;

2 - descending part;

3 - horizontal part;

4 - ascending part;

5 - beginning of the jejunum;

6 - pancreatic duct.

The duodenum, with the exception of its upper part adjacent to the pylorus, is located retroperitoneally. It is about 20 cm long (9-30 cm) and 1.5-5 cm wide.

Duodenal bulb mobile, the rest of the part is fixed to the posterior wall of the abdomen.

DPK form closer to a horseshoe, there are several complex bends.

Upper bend short, lies to the right of the spine at the level of the II thoracic or I lumbar vertebra, has a horizontal or ascending direction.

Descending part It also lies to the right of the spine and looks like a loop.

The lower horizontal part of the WPC located approximately at the level of the III lumbar vertebra, crosses the spine and to the left of it at the level of the II lumbar vertebra passes into the jejunum.

The wall of the duodenum consists in the upper part of 3 shells -

1. serous,
2. muscular,
3. mucous,

1. muscular and
2. mucous membrane.

The mucous membrane of the duodenum has 2 layers -

1. epithelial and
2. muscular.

On the inner surface of the mucosa there are many villi up to 0.5 mm high, rich capillary network And lymphatic vessels. Above the villi, in the own layer of the mucosa, there are crypts - tubular depressions lined with epithelium. The muscular layer of the mucous membrane consists of several thin muscle fibers.

Submucosa It is a loose connective tissue, in the thickness of which the duodenal (Brunner's) glands are located.

In the descending section of the duodenum there is Vater's papilla, 11-21 mm high, 5-10 mm wide. At its apex the common gall and pancreatic ducts(approximately 70% in the form of a single duct). The final part of the common bile duct in the wall of the duodenum is covered by the sphincter of Oddi.

The duodenum lies in close proximity to a number of important organs:

• adjacent to the stomach
• and the upper, descending, horizontal part touches the head of the pancreas,
• the ascending part is the body of the pancreas.
• KDP is located nearby right lobe liver,
• aorta,
• right adrenal gland
• inferior vena cava.

The duodenum is located to the left and back of the gallbladder, the anterior or anterior-inferior edge of the bulb is in contact with the body of the gallbladder.

Lymphatic system of the duodenum

The lymphatic system of the duodenum is well developed, the vessels flow into the lymph nodes located in front and behind the head of the pancreas, in the mesentery at the border with the pyloric part of the stomach, partially the lymph flow goes to the hepatic node, to the blood nodes of the mesentery.

Physiology of the duodenum

The duodenum is anatomically and functionally a continuation of the stomach; it receives food from the stomach, mixing of duodenal juices, pancreatic juices and bile occurs in it, as well as the absorption of some digestive products.

The main physiological role of bile is carried out in the duodenum- “replace gastric digestion with intestinal digestion, destroying the effect of pepsin as a dangerous agent for pancreatic juice enzymes, and extremely favoring pancreatic juice enzymes, especially fatty juice” (I.P. Pavlov, 1951).

Activation occurs in the duodenum protein, fat and starch enzymes. Here, emulsification with bile and processing of food masses with pancreatic juice occurs, hydrolytic breakdown of nutrients occurs, that is, digestion in the proper sense.

The duodenum plays a significant role as a receptor zone, providing big influence on food transport processes and the secretory function of the pancreas. The hormones it secretes (enterogastron, secretin, cholecystokinin, pancreozymin, villikinin, enterokinin) actively influence the activity of the stomach, pancreas, liver, and intestines.

Examination of the duodenum

When examining the duodenal area in a healthy person, no abnormalities are detected, the abdominal wall is actively involved in the act of breathing, the level of its surface is similar to the level of the symmetrical area on the left. The skin color does not differ from the skin color of other areas of the abdomen. The thickness of the subcutaneous fat layer is normal.

Pathology of the duodenum(duodenitis, ulcer, tumor) are often accompanied by a decrease in the patient’s nutrition, pallor of the skin during bleeding and perforation of the ulcer, and hyperpigmentation of the skin of the duodenal area.

When an ulcer perforates- non-participation of the abdomen in the act of breathing, board-shaped abdomen. In persons who have undergone surgery on the duodenum, a scar is visible from the xiphoid process to the navel. With duodenal stenosis, as with pyloric stenosis, there will be a noticeable bulging of the epigastrium predominantly on the left, periodic waves of peristalsis of a full stomach from the left hypochondrium down to the navel, fading a few seconds after their occurrence. In this situation, other parts of the abdomen usually look sunken.

Palpation of the duodenum

Palpation (Fig. 416). Its close proximity to other organs and its deep location do not allow us to confidently attribute the identified palpation findings only to this organ.

A. Scheme of the topography of DP K
B. The position of the doctor’s hand during palpation, the hand is placed flat on the stomach on the right at the outer edge of the rectus muscles, the position of the fingertips is 1-2 cm below the costal arch or the edge of the liver

Taking into account the physiological variations in the structure and position of the duodenum, palpation begins from the lower edge of the liver at the lateral edge of the right rectus abdominis muscle. 4 fingers right hand are installed 1-2 cm below the edge of the liver.

Having shifted the skin upward, gradually, as you exhale, your fingers plunge into the depths. Upon reaching back wall on the next exhalation of the subject, the fingers make a sliding movement downward by 2-4 cm. Palpation must be repeated, dropping from the initial level of the study by 3-4 cm.

In this way, the initial, descending and partially lower horizontal part of the duodenum will be palpably examined. In a healthy person, the duodenum is not palpable. Palpation is painless.

Pain on palpation of the duodenum observed during its inflammation, erosive and ulcerative process, and periduodenitis. Palpation of a dense cord as thick as a little finger indicates a pronounced spasm of the duodenum, which is possible with a peptic ulcer. The presence of an area of ​​compaction suggests periduodenitis or tumor.

Examination of patients with diseases of the gastroduodenal region begins with questioning. Most often, these patients complain of pain in the epigastric region, nausea, belching, vomiting, and changes in appetite. However, these complaints are quite common in pathologies of other organs and are therefore not very specific. Data from physical examination of patients (examination, palpation of the abdomen) are usually uninformative. Due to this crucial in the diagnosis of diseases there are additional research methods, primarily gastroduodenoscopy and x-ray examination.

Questioning

Complaints. Pain in the abdomen, caused by gastric pathology, are usually localized in the epigastric region and can be either constant or paroxysmal. The most typical are paroxysmal pain associated with eating, occurring shortly after eating after a certain period of time or passing after eating. Patients may complain of a vague painful feeling of pressure or tension in the epigastric region associated with stomach fullness and bloating. Pain associated with stomach disease occurs as a result of disturbances in the motor function of this organ (with spasm or stretching of the smooth muscle fibers of its wall).

Heartburn- a burning sensation in the esophagus caused by reflux of gastric contents.

Nausea -unpleasant feeling in the epigastric region. In diseases of the stomach it is usually accompanied by pain.

Vomit- paroxysmal release of stomach contents into the esophagus and further into the oral cavity as a result of contractions of the abdominal press, movements of the respiratory muscles with the pylorus closed, often combined with nausea and abdominal pain. In patients with stomach disease, the pain usually subsides after vomiting.

Belching- sudden release of a small portion of gastric contents into the oral cavity due to compression of the stomach between the diaphragm, abdominal wall and swollen bowels or pyloric spasm.

Change in appetite- its decline is widespread. Lack of appetite - anorexia- a common symptom of stomach cancer.

History of the disease. The onset of the disease can be acute (gastritis after an error in diet) or gradual. Exacerbations and long periods of remission (with peptic ulcer disease) are often observed. Progression of the disease is typical for stomach cancer. It is always important to clarify the connection between stomach disease and intake medicines, for example with non-steroidal anti-inflammatory drugs.

Physical research methods

A general examination of the patient reveals weight loss (even cachexia), pallor of the skin associated with anemia, and a tongue coated with a white coating.

Superficial palpation of the abdomen often reveals pain in the epigastric region and slight tension in the abdominal muscles, usually associated with peptic ulcer or gastritis.

Deep sliding palpation only occasionally makes it possible to palpate the lesser and greater curvature and pyloric parts of the stomach and, even more rarely, a stomach tumor. Percussion and auscultation of the stomach, as a rule, are not significant.

Additional research methods

X-ray examination. First of all, it is necessary to prepare the patient for the study. For this purpose, the night before and in the morning on the day of the study, his intestines are cleansed using enemas, and for persistent constipation, laxatives are prescribed. The study is carried out on an empty stomach, in vertical position sick. Barium sulfate is used as a contrast. The study begins with determining the relief of the gastric mucosa, the folds of which have great variations and often change depending on the stage of the digestion process, sometimes becoming more prominent and distinct, sometimes flattening. If their course is interrupted, they assume the presence in this place pathological process. It is important to study the contours of the stomach. A persistent protrusion of its shadow is designated as a niche, which is a typical sign of gastric ulcer. The absence of filling of the stomach area with contrast mass is called a filling defect and is an important symptom of a neoplasm.

Gastroduodenoscopy. With the use of fiber optics, gastroduodenoscopy has received intensive development and has become the most effective and quickly applied method. Simultaneous biopsy and morphological examination made this method the most effective diagnostic method. The main indication for gastroduodenoscopy is bleeding from the upper gastrointestinal tract and epigastric pain. Great importance this method also lies in the possibility of using local treatment with continued bleeding. The advantage of gastroscopy is the ability to detect superficial changes in the mucous membranes that are not detected radiographically. In the presence of a gastric ulcer detected by X-ray examination, endoscopy is usually also required to visually and histologically exclude an ulcerated tumor. For any suspicion of a stomach tumor, including the presence of symptoms such as weight loss, anemia, an endoscopic examination is necessary.

Biopsy of the gastric mucosa and cytological examination . This method is used to exclude or confirm the presence of a tumor. In this case, tissue for examination is taken in several (preferably 6-8) places, the accuracy of the diagnosis in this case reaches 80-90%. It must be taken into account that both false positive and false negative results are possible.

Study of gastric juice. The study is carried out using a thin probe, the introduction of which requires active assistance the subject being studied. A portion of gastric contents is obtained on an empty stomach and then every 15 minutes after administration of the stimulus. The acidity of gastric contents can be determined by titrating it with 0.1 mmol/l NaOH solution in the presence of the indicators dimethylaminoazobenzene and phenolphthalein (or phenol red) to pH 7.0 while neutralizing the acidic contents with alkali.

Basal acid secretion is the total amount of hydrochloric acid secreted in the stomach over four 15-minute periods of time and expressed in mmol/h. This indicator normally ranges from 0 to 12 mmol/h, with an average of 2-3 mmol/h.

Study of stimulated secretion of hydrochloric acid. The most powerful irritants of gastric secretion are histamine and pentagastrin. Since the latter has fewer side effects, it is now being used more and more often. To determine basal acid secretion, pentagastrin or histamine is administered subcutaneously and gastric contents are collected over four 15-minute periods. As a result, the maximum acid secretion is determined, which is the sum of the maximum consecutive secretion values ​​for 15 minutes of gastric juice collection.

Basal and maximum acid secretion is higher in patients with an ulcer localized in the duodenum; when an ulcer is located in the stomach, acid secretion in patients is less than in healthy people. Benign gastric ulcers rarely occur in patients with achlorhydria.

Study of gastrin in blood serum. Determination of gastrin content in serum is carried out using the radioimmune method and can have diagnostic value for diseases of the gastroduodenal zone. Normal values this indicator on an empty stomach is 100-200 ng/l. An increase in gastrin content of more than 600 ng/l (severe hypergastrinemia) is observed in Zollinger-Ellison syndrome and pernicious anemia.

Unpleasant sucking pain in the pit of the stomach, an increased feeling of hunger in the morning, slight nausea - these are the symptoms that most often begin with duodenal ulcers. Unfortunately, the symptoms that the body uses to signal the development of an illness are rarely taken seriously. Most people don't even think about how serious illness is approaching. After all constant pain and severe complications of this pathology occur much later. What is a duodenal ulcer? And how can it be detected in a timely manner?

Description of the pathology

Duodenal ulcer (or duodenal ulcer, duodenal ulcer) is a chronic disease of a relapsing nature, which is characterized by the formation of ulcers concentrated on the wall of the affected organ. Pathology is formed under the influence of aggressive stomach contents on the mucous membrane, including hydrochloric acid and pepsin, an enzyme produced during the digestion process.

The WPC wall consists of several layers:

• slime layer,
• submucosal,
• muscle layer.

An ulcer is a defect, the bottom of which is localized in the muscle layer. The submucosa, as well as the mucosa, are practically not destroyed. Most often, ulcers form in the initial parts of the duodenum - bulb, bulb. This is where reflux of gastric contents most often occurs. In addition, in this place all conditions have been created for the growth and reproduction of bacteria leading to peptic ulcer disease.

The pathology is recurrent in nature. Periods of calm are followed by painful exacerbations. Most often, the disease is diagnosed in the male population.

A duodenal ulcer can form as a result of the harmful effects of Helicobacter pylori bacteria. In addition, it is known that the disease often develops against the background of regular use of anti-inflammatory drugs, such as Ibuprofen, Diclofenac, Aspirin. Smoking, drinking alcohol, and poor diet make a significant contribution to the development of peptic ulcers.

Ulcerative disease - video

Classification of pathology

Peptic ulcer pathology is classified by doctors into several specific types.

According to the number of ulcers formed, the pathology can be:

• single;
• multiple.

Analyzing the frequency of exacerbations, we distinguish:

• peptic ulcer disease with rare exacerbations - acute symptoms the patient is observed once during 24 months;
• pathology with frequent relapses - manifestations of the disease are observed once every 12 months, sometimes more often.

Depending on the depth of damage to the wall, the pathology can be:

• superficial - it is characterized by a slight defect;
• deep - the ulcer has a large lesion.

Considering the condition of the ulcer, doctors classify the pathology into:

1. Stage of active exacerbation. The patient exhibits all the symptoms of the pathology: nausea, vomiting, severe pain syndrome etc.
2. Scar formation. A healing ulcer leaves behind a small scar - a scar.
3. Remission stage. The patient temporarily does not have any symptoms of the disease.

In addition, the following types of duodenal ulcers are distinguished:

1. Acute pathology:
   1. accompanied by bleeding;
   2. pathology with perforation (a through hole is formed in the wall of the duodenum);
   3. a disease characterized by perforation and bleeding;
   4. a pathology in which neither perforation nor bleeding is diagnosed.
2. Chronic duodenal ulcer:
   1. unspecified illness with bleeding;
   2. unspecified pathology, accompanied by perforation;
   3. unspecified disease in which perforation and bleeding are observed;
   4. a disease that occurs without bleeding or perforation.

Symptoms characteristic of duodenal ulcers

A duodenal ulcer is characterized by a number of distinctive symptoms. However, signs of the disease usually appear only during an exacerbation. During the period of remission, the disease is most often asymptomatic.

General symptoms

The main clinical manifestations of duodenal ulcers are the following:

1. Pain. Unpleasant sensations are localized in the upper abdomen. This is the most common symptom of peptic ulcer disease. The appearance of pain is directly related to hunger. The discomfort subsides after eating. That is why discomfort with duodenal ulcers is called “hunger pain.” Unpleasant sensations may vary in the nature of their manifestation. The pain can be severe, piercing, or quite moderate, aching. Sometimes they radiate to the back or heart.
2. Hunger. Many patients claim that an unpleasant feeling of hunger occurs several hours after eating food.
3. Night pain. With a duodenal ulcer, night awakenings may occur, triggered by severe abdominal pain. According to statistics, discomfort during sleep is one of the main symptoms peptic ulcer DPK. This symptom is observed in almost 80% of patients. This symptomatology is provoked by a physiological process, because at 2 a.m. the synthesis of hydrochloric acid reaches its peak in the stomach. The body reacts to increased acidity with pain and awakening.
4. Flatulence, belching, heartburn. These manifestations are caused by impaired motor activity intestines and stomach, as well as inflammatory changes in the mucous membrane. As a result of such processes, acidic contents from the stomach begin to be thrown into the esophagus, burning it and causing extremely negative sensations.
5. Bloating, nausea, vomiting. These manifestations are usually characterized by a high duodenal ulcer. If the pathology is accompanied by inflammation of the gallbladder or pancreas, then bile is observed in the vomit.
6. Vomiting with blood. Similar symptoms characterize advanced stage illness. Blood may also be observed in the patient's stool. The presence of blood streaks indicates dangerous condition - internal bleeding. Ignoring such symptoms is very dangerous, since the risk of death is high.
7. Appetite disorder. The patient may experience a voracious appetite caused by constant sucking epigastric region and a feeling of hunger. Eating food slightly smoothes out the unpleasant symptoms. Some people have fear and aversion to food. This clinic is caused by severe pain that occurs after eating.

Signs of an ulcer with bleeding

Duodenal ulcer, complicated by bleeding, most often occurs in men. And as a rule, at the age of 40–50 years. This is a rather complex condition with a very high mortality rate.

Bleeding develops as a result of neutrophic lesions on the walls of the duodenum. Pathology can be caused by: hypovitaminosis, physical, psycho-emotional stress, vascular damage in the gastroduodenal area, abdominal trauma.

The following symptoms are characteristic of this pathology:

1. Presence of bleeding. It can be massive or insignificant. The latter condition most often occurs due to drug abuse. A small ulcer may bleed daily. The patient loses blood along with feces. The stool may not even change color to black. With minor bleeding, a person will usually have no symptoms other than extreme fatigue.
2. Changing the stool. With massive bleeding, extreme characteristic symptoms. There is unpleasant nausea, diarrhea, and sometimes slight chills. Loose stool takes on a black tint. In some cases, patients experience fainting after defecation.
3. Vomiting blood. Sometimes dark clots may be found in the vomit. They characterize the effect of hydrochloric acid on hemoglobin.
4. Compensatory reactions. With significant blood loss, a catastrophic decrease in its volume is observed. As a result, the patient experiences certain compensatory reactions, which are manifested by vascular spasms, a rapid drop in pressure, and pale skin. An electrocardiogram diagnoses myocardial hypoxia.
5. Vascular collapse. Massive bleeding occurs rapidly. The patient develops dizziness, excessive weakness, and tachycardia. Usually the pathology is accompanied by low-grade fever (about 37.5–38 C).
6. Pain syndrome. Most often, the discomfort that debilitates the patient before bleeding begins completely disappears. If the pain continues to torment a person, then the prognosis worsens significantly.

Symptoms of pathology with perforation

A perforated ulcer is another extremely serious complication of this disease. It is characterized by the appearance of a through defect in the wall of the duodenum. This symptomatology is typical of men aged 20–40 years.

A similar illness is caused by a prolonged course of an ulcer, usually asymptomatic. The insidiousness of the disease lies in the fact that a perforated ulcer is most often accompanied by bleeding. And it is to the bleeding that the doctor’s attention shifts.

The symptoms of this disease must be considered in connection with the stages of the perforated ulcer:

1. First stage. The patient is in shock. The duration of this period is the first 6 hours. The following symptoms are characteristic of this stage:
   1. sharp pain in the epigastric region, reminiscent of a dagger strike;
   2. the appearance of vomiting;
   3. immobility of the patient (usually the legs are pulled up to the stomach);
   4. pale skin;
   5. slight cyanosis of the lips (blue discoloration);
   6. presence of cold sweat;
   7. shallow breathing;
   8. decreased blood pressure;
   9. touching the stomach is painful;
   10. slight drop in heart rate;
   11. The stomach and buttocks are tense and become rigid, resembling a board.
2. Second stage. It is characterized by an imaginary improvement. Most often, this stage is characterized by the following symptoms:
   1. pain reduction;
   2. decrease in muscle tension;
   3. the development of peritonitis, which is indicated by the following signs: the appearance of tachycardia, euphoria is observed, the temperature rises, the surface of the tongue is dry, flatulence, stool retention;
   4. leukocytosis gradually increases;
   5. The pain increases significantly during palpation on the right, in the iliac region.
3. Third stage. Most often it occurs 12 hours after the previous stage. During this period, the patient exhibits all the symptoms of diffuse peritonitis. The person's condition is rapidly deteriorating. The following symptoms may indicate stage 3:
   1. frequent vomiting;
   2. excessive dryness of the skin and mucous membranes;
   3. high patient anxiety;
   4. increased breathing;
   5. bloating;
   6. elevated temperature;
   7. low pressure;
   8. pulse can reach 120 beats;
   9. dry tongue with a dirty, brown coating.

Scar stenosis

Ulcers tend to scar. However, not everything is so simple here either. If the patient experiences frequent exacerbations of the disease, then the erosive defects are usually quite deep and large. Scars from such ulcers can deform the intestine or narrow its lumen. This leads to poor passage of food. Doctors diagnose stenosis, or narrowing of the intestine. This pathology requires surgical intervention.

The following symptoms may indicate stenosis:

• vomit;
• stomach distension;
• the appearance of pain after eating;
• increased weakness, lethargy;
• constant drowsiness;
• increased muscle tone;
• feeling of “pins and needles” on the surface of the limbs.

Features of the course of the disease in women, children, and the elderly

Depending on the gender and age of the patient, peptic ulcers have some nuances.

Features of the disease in women

Women are characterized by the following characteristics:

1. Ulcers are most often observed in the duodenal bulb.
2. Patients usually indicate a clear alternation of exacerbation and stages of remission.
3. Pain in women is not as pronounced as in men.
4. According to statistics, representatives of the fairer sex rarely encounter complications of the disease.
5. During menopause or menstrual irregularities, peptic ulcer disease worsens. During these periods, the disease is extremely difficult.
6. Pregnant women almost always experience a remission stage. But abortion can, on the contrary, provoke a relapse of the pathology.

Course of the disease in children

Unfortunately, peptic ulcer disease is often diagnosed in adolescence and childhood. At the same time, injuries to the duodenum are more often found in children. Teenagers mostly suffer from stomach ulcers.

The disease in children has some characteristic features:

1. In most cases, the disease occurs with a minimum number of symptoms:
   1. heartburn;
   2. a feeling of fullness or heaviness in the epigastric region;
   3. unpleasant sensations arise after a certain time;
   4. after eating rough spicy food, pain may occur;
   5. discomfort is felt after intense physical activity or emotional stress;
   6. the pain is mild;
   7. sometimes dyspeptic disorders are possible.
2. Very often in children, peptic ulcer disease is accompanied by pathologies of other organs of the digestive tract. The hepatobiliary system is often affected.
3. Children and adolescents extremely rarely encounter negative complications.
4. With complete and proper treatment, ulcers heal very quickly.

Features of the disease in old age

In old age, peptic ulcer disease is quite severe. After all, patients experience physiological aging of the body. In addition, most people already suffer from various chronic ailments.

The following features of the course of peptic ulcer disease in old age are known:

1. Complications (such as bleeding or sudden perforation) often develop.
2. Ulcers heal extremely slowly.
3. Patients usually have dyspeptic syndrome.
4. Erased symptoms of the pathology are often observed.
5. Painful discomfort is moderate.
6. At this age, the risk of developing stomach cancer is high.

Diagnosis of the disease

If a person is faced with unpleasant symptoms reminiscent of a duodenal ulcer, then to make the correct diagnosis it is necessary to contact a gastroenterologist. In case of acute clinical manifestations, you need to call an ambulance. The attending physician for such patients is a surgeon.

Initial patient appointment

A competent specialist can suspect the presence of a peptic ulcer at the initial appointment.

To do this, the gastroenterologist will study:

1. History of the disease. The doctor will ask when the pain began, whether it is related to eating, and whether the night discomfort is tormenting. It is necessary to answer what the painful manifestations of the disease are associated with, according to the patient.
2. Anamnesis of life. The doctor needs to explain in detail about your lifestyle, diet, and diet. You will need to talk about the quality of the stool (quantity, shade of stool, frequency of bowel movements, presence of pain during bowel movements). In addition, it is important to inform the specialist about previously diagnosed pathologies of the digestive tract, such as gastritis, duodenitis.
3. Visual inspection. Initially will be appreciated general state(pallor of the skin, pressure, etc.). Based on the condition of the tongue, the doctor is able to identify some pathologies. A moist and red surface indicates a peptic ulcer. If the tongue becomes dry and stiff, it signals the development of intoxication in the body. Examination of the abdomen and palpation will make a significant contribution to the diagnosis. With the help of such an event, the doctor will assess the presence of bloating, flatulence, and “board-shaped” muscle tension.

Lab tests

1. General blood analysis:
   1. a peptic ulcer is indicated by a slight increase in red blood cells in the body and an increased level of hemoglobin; if the pathology is not complicated, then slight lymphocytosis is observed;
   2. perforation is indicated by a decrease in ESR, significant leukocytosis, toxic granularity in neutrophils;
   3. about acute blood loss evidence of low hemoglobin, reduced number of red blood cells, altered content of leukocytes, platelets;
   4. stenosis is characterized by an increase in ESR and anemia.
2. Analysis of urine. In the absence of complications, this study doesn't show any changes.
3. Blood biochemistry:
   1. uncomplicated pathology does not cause any special changes;
   2. in the case of peritonitis, against the background of perforation, the presence of urea is observed in the blood;
   3. stenosis is indicated by decreased total protein, decrease in electrolytes (typical of dehydration), altered acid-base state;
   4. typical for perforation increased number gamma globulins, bilirubin;
   5. in case of malignancy (degeneration into cancer), the appearance of lactic acid in gastric juice, Boas-Osler lactic acid bacilli, progressive anemia.
4. Stool analysis. This test can detect hidden blood in stool. It makes it possible to detect Helicobacter pylori in the patient’s stool.

Instrumental diagnostics

To accurately determine the diagnosis, you will need to conduct the following studies:

1. Study of acidity. This study is called intragastric pH-metry. This examination is intended to study the interaction between aggressive and protective factors in the stomach area. In a healthy person they are in balance.
2. Esophagogastroduodenoscopy. Using a special device (endoscope), the mucous membrane is examined digestive system(esophagus, stomach, duodenum). EGD allows you to detect ulcerative defects, gives an idea of ​​their quantity and location. In addition, during the procedure, a biopsy (a piece of tissue) is taken for further study.
3. X-ray. An image of the peritoneum can reveal a complication of a peptic ulcer, such as perforation. To detect stenosis or tumors, the patient needs to drink barium before the test.
4. Cytological examination. A detailed study of the tissues taken allows us to identify a bacterium such as Helicobacter pylori. In addition, this diagnosis detects cancer at an early stage.

Differential diagnosis

Peptic ulcer disease has many symptoms that are clinically similar to a wide variety of duodenal ailments. Therefore, the doctor, before he makes a diagnosis, has to differentiate a duodenal ulcer from many other pathologies.

Distinctive features - table

Name of the disease	Features of symptoms	Differential diagnostic measures
Chronic gastritis	seasonality of pain is unusual; moderate pain; no increase in pain is observed.	X-ray of the stomach; endoscopic examination.
Duodenitis, pyloroduodenitis	The symptoms are completely similar to duodenal ulcers, characterized by the presence of “hungry” pains and waking up at night.	x-ray (detects hypertrophied folds with granular relief); gastroduodenoscopy.
Oncology	the presence of symptoms in elderly people; high fatigue; aching constant pain; discomfort does not depend on food intake.	blood analysis; study of treatment dynamics (lack of positive results); fluoroscopy; cytology; gastroscopy with biopsy.
Gallstone disease, chronic cholecystitis	Features of gallstone pathology: Mostly women with obesity or hypertensive constitution suffer; there is no frequency of exacerbation stages; discomfort occurs after eating certain foods (mushrooms, fatty foods, marinades, spicy dishes); pain occurs in different periods after eating; discomfort varies in intensity and duration; the pain is paroxysmal in nature (reminiscent of colic); discomfort often radiates to the right shoulder blade, shoulder; jaundice may appear. Chronic cholecystitis will be indicated by: short periods of exacerbation; enlarged liver.	blood and urine tests; X-ray; endoscopy.
Chronic pancreatitis	pain appears after eating fatty foods; the discomfort is of a girdle nature; pain radiates to the left shoulder and shoulder blade; discomfort becomes cramping in nature.	urine analysis (increased diastase, glucosuria); X-ray; endoscopy; pancreas scan; pancreatography; angiography.
Chronic appendicitis	exacerbations are observed periodically, with short-term pain; discomfort increases with physical exertion and walking; the pain zone is clearly identified (this is the ileocecal area).	X-ray of the gastroduodenal and ileocecal zone.
Diverticula of the duodenum	No distinctive features are observed.	X-ray examination; gastroduodenoscopy.

There are diseases that are better to prevent than to fight them, periodically experiencing painful symptoms. Undoubtedly, duodenal ulcer is just such a pathology. Therefore, at the first unpleasant symptoms, you should immediately contact a gastroenterologist. After all, timely treatment is the key to a long and healthy life.